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Centivo is seeking a Director of Claims Management Ancillary Services (CMAS) to own the strategy, performance, and regulatory compliance of the company's claims ancillary functions, with particular emphasis on plan documents. This role directly manages two managers—the Plan Documents Manager and the CMAS Manager—and is accountable for the accuracy, timeliness, and regulatory compliance of plan documents (SBCs, SPDs, SMMs, amendments) and the performance of claims audit, appeals, escalations, recoveries, subrogation, and No Surprises Act (NSA) functions.
Key responsibilities include developing and executing plan document strategy while ensuring compliance with ERISA, IRC, HIPAA, MSP, COBRA, ACA, and WHCRA. The Director will establish document governance standards, review workflows, and quality checkpoints; partner with Legal, Compliance, Configuration, and Client Success teams; and serve as the escalation point for complex plan document and client-specific issues. On the CMAS side, the role owns end-to-end performance of claims functions, establishes and monitors operational and quality KPIs, directs workforce and capacity planning, drives process improvement and automation, and oversees policy development and enforcement.
People leadership is central: the Director will manage two direct reports, provide coaching and performance feedback aligned to Centivo's leadership behaviors (Communicate, Clarify, Coach, Connect, Customize), set clear performance expectations, and foster a culture of accountability and collaboration. The role also represents CMAS and Plan Documents in cross-functional meetings, client calls, and discussions with brokers, agents, TPAs, and stop loss carriers, serving as the operational authority for these functions.
Required qualifications include 7+ years in employee benefits compliance, plan document administration, or healthcare claims operations at a TPA, health plan, or benefits consulting firm; 5+ years of leadership experience managing managers or teams; deep knowledge of ERISA, IRC, HIPAA, MSP, COBRA, ACA, and WHCRA; demonstrated experience overseeing plan document drafting and management; experience overseeing claims audit, appeals, recoveries, subrogation, NSA, or quality assurance functions; strong data literacy; cross-functional collaboration experience; and a Bachelor's degree (paralegal certification or advanced degree preferred). Preferred qualifications include employee benefits paralegal background, experience with Phia Group's PDM portal or similar systems, claims adjudication system experience, claims system implementation/transformation leadership, and client-facing or account management experience.
